Transcript 4th Quarter Powerpoint

POISONS!!
ALL CHEMICALS CAN BE TOXIC TO HUMANS PROVIDED . . .
Epidemiology
A quarter of a million died worldwide as a result
of intentional poisoning while 350,000 people
died of accidental poisoning. (WHO, 2002)
Poisoning is the impairment of normal
metabolic functions due to exposure to
harmful substances.
Epidemiology
WHO?
Children less than 5 y.o.
WHERE?
Over 90% happen at home
HOW?
Ingestion
WHAT?
Cleaning fluids, OTC
WHY?!?
Types of poisoning
PGH Poison Center 5241078/521-8450
1.Food
[email protected]
2.Heavy metal / Chemical
3.Drug
Types of poisoning
1.Ingested
2.Inhaled
3.Injected
4.Absorbed
Ingested Poison
Signs and Symptoms
• Altered mental status.
• History of ingesting poisons.
• Burns around the mouth.
• Odd breath odors.
• Nauseas, vomiting.
• Abdominal pain.
• Diarrhea.
Mouth
• Breaks down food into small pieces
• Begins starch digestion (amylase)
• Saliva produces amylase and lubricates
food
• Limited absorption
Esophagus
• Made up of smooth muscles (2 types)
• Epiglottis covers trachea
• Peristalsis moves food to stomach
Stomach
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First opening – cardiac sphincter
Mechanical and chemical digestion
Glands produce pepsin and HCl
Pepsin breaks down proteins
Food leaves after 2-4 hrs
Second opening – pyloric sphincter
Intestines
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2 types (Large and Small)
Pancreatic juice and bile is secreted
Mostly chemical digestion
Absorbs monomers of carbohydrates, fats,
and proteins, and water
• In-house bacteria that produces vitamin K
Inhaled Poisons
Signs and Symptoms
• History of inhaling poisons.
• Breathing difficulty.
• Chest pain.
• Cough, hoarseness, burning
sensation in the throat.
• Cyanosis (bluish discoloration of
skin and mucous membranes).
• Dizziness, headache.
• Seizures, unresponsiveness
(advance stages).
Absorbed Poisons
Signs and Symptoms
• History of exposures.
• Liquid or powder on the skin
• Burns.
• Itching, irritation.
• Redness, rashes, blisters
General Principles for Poisoning
Management
• Prioritize the ABC’s of life
• Obtain as much info about the exposure
as possible
• Call the Poison Control Center
• Identify method of administration
First Aid for Ingested Poison
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Gastric emptying
Limit absorption
Catharsis
Chelation
Antidote
First Aid for Inhaled Poisons
• Check ABCs
• Get patient into open space for fresh area
• Open airway if necessary
Drug Overdose
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Hallucinogens
Stimulants
Depressants
Club Drugs
Blood Alcohol levels > 4.5g/L is FATAL!
Poison/Drug
Antidote
paracetamol (acetaminophen)
N-acetylcysteine
vitamin K anticoagulants, e.g.
warfarin
vitamin K
opioids
naloxone
iron (and other heavy metals)
desferrioxamine, Deferasirox or
Deferiprone
benzodiazepines
flumazenil
ethylene glycol
ethanol, fomepizole or Thiamine
methanol
ethanol or fomepizole
cyanide
amyl nitrite, sodium nitrite &
sodium thiosulfate
Organophosphates
Atropine & Pralidoxime
Magnesium
Calcium Gluconate
Calcium Channel Blockers
(Verapamil, Diltiazem)
Calcium Gluconate
Beta-Blockers (Propranolol,
Sotalol)
Calcium Gluconate and/or
Glucagon
Isoniazid
Pyridoxine
Atropine
Physostigmine
Acidosis
A metabolic condition brought about by
inability of the blood buffer system to
maintain normal pH in the blood. This
condition could lead to coma or death.
Examples include lactic acidosis and
ketoacidosis
Diabetes Mellitus
A disease characterized by the inability of
the body to produce sufficient amounts of
insulin which leads to erratic changes in
blood sugar levels (FBS = 120 mg/dL)
Type I (IDDM)
Type II (NIDDM)
Hyperglycemia
Causes
Symptoms
1.Too much sugar in food 1.Thirst
2.Low insulin level
2.Dehydration
3.Weakness
4.Tachycardia
5.Sweet breath odor
Active
Passive
Characteristics of Adequate Breathing
• 12 – 20 breaths per minute
• regular consistent pattern
• regular breath sounds
• movement localized in the chest cavity
Characteristics of Inadequate Breathing
• fast and shallow
• irregular breath sounds
• movement along the shoulder
• cyanotic skin
Common Respiratory Emergencies
COPD
- A group of diseases characterized by prolonged and
difficult exhalation, chronic cough, or airway obstruction
due to repeated infections or inhalation of toxic agents.
1. Chronic Bronchitis
2. Emphysema
3. Asthma
Pneumothorax
- Accumulation of air in pleural space causing the lungs to
collapse
Hyperventilation
Symptoms of COPD
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Coughing - “smoker’s cough”
Shortness of breath
Excess sputum or phlegm
Feeling like you can’t breathe
Can’t take deep breath
Wheezing
Emphysema
Alveoli distention
which breaks
down the thin
walls.
Chronic Bronchitis
Inflammation,
edema, and
excessive mucus
production
Asthma
Normal
Inflamed
• common to
children
• 12% to 22%
prevalence
Acute spasm of bronchioles
First Aid for Breathing Difficulties
1.Control the environment
2.Provide Medications
3.Give Artificial Ventilations
4.Perform simplified Cricothyroidotomy
SEIZURES
. . . it’s not a disease . . .
Definition
Seizures are altered states of consciousness due to
uncontrolled abnormal electrical activity of the brain
Its cause may vary from . . .
1.Epilepsy
2.Febrile
3.Head Injury
4.Metabolic Conditions
5.Drug Overdose
Types of Seizures
Partial versus General
Simple versus Complex
Lose consciousness? Convulsions?
Whole body?
Phases of a Grand Mal Seizure
• Aura
a warning sign perceived by the patient
• Tonic
patient becomes unresponsive and
exhibits muscle rigidity
• Clonic
patient experiences alternating episodes
of muscle spasms and relaxation
• Postictal recovery phase and could last up to 30min
Seizures are generally harmless and selflimited but if it lasts more than 5 minutes it
can be life threatening . . . Why?!?
What to do during . . .
• Protect the patient / support the head
• Loosen tight clothing
• Roll the victim onto the side
• Do not give anything by mouth except for
medications (i.e. diazepam, lorazepam,
midazolam)
• Do not restrain the patient single handedly
• Remove dangerous objects from vicinity
What to do after . . .
• Let the patient lie on the side
• Remove vomit / saliva from mouth
• Check for breathing
• Check for head trauma
• Transport to hospital
To Move or Not To Move?
Moving an injured person is a judgment call!!!
Here are some tips to help you decide . . .
• pain and discomfort of victim
• safety of rescuer and victim
• risk of further injury
• site not conducive for CPR
• training and skill of rescuer
Guidelines for Moving a Victim
• assess condition of victim
• do not move if moving will make injuries worse
• splint all fractures
• pull along the long axis
• more movers are preferred
• check vital signs before and after moving
Moving Techniques
Blanket drag (1)
Seat carry (2)
Ankle drag (1)
Extremity lift (2)
Firefighter’s carry (1)
Chair carry (2)
Cradle carry (1)
Flat lift and carry (3)
Pack strap carry (1)
Hammock carry (3)
Piggyback carry (1)